Copyright © 2004 by the European Society of Cardiology.
Current opinion
Coronary flow: a new asset for the echo lab?
a Institute of Cardiology, University of Rome, "La Sapienza", Rome, Italy
b Institute of Cardiology, Department of Internal Medicine, University of Rome, "Tor Vergata", 00100 Rome, Italy
* Correspondence to: Paolo Voci, Institute of Cardiology, University of Rome, Via San Giovanni Eudes, 27, 00163 Rome, Italy. Tel.: +39 06 6615 8122; fax: +39 06 2090 0382 (E-mail: voci@uniroma1.it).
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Introduction
Non-invasive imaging of coronary blood flow by transthoracic Doppler echocardiography is an emerging diagnostic tool to study the left anterior descending (LAD)1–11 and posterior descending (PD) coronary arteries.12–15 With this new clinical application of echocardiography, we can directly measure changes in coronary flow velocity reserve (CFVR) at the very beginning of the ischaemic cascade, instead of looking at the consequences of ischaemia on myocardial contraction, as it is routinely done with dobutamine stress echocardiography and other stress tests.
Since its introduction in 1997,1,2 it has been clear that transthoracic coronary Doppler ultrasound could provide useful information in the diagnosis of coronary artery disease (CAD)3–15 follow-up of percutaneous coronary interventions,16–21 coronary recanalization in acute myocardial infarction (AMI),22–26 and coronary microcirculation.27–33.
The importance of measuring CFVR in routine clinical practice has been anticipated over 20 years ago by the physiologist Carl Honig: "One of the principal tasks of a physician is
Before holding the probe
The window
Proximal or distal?
Baseline flow velocity
The magic couple: adenosine and Doppler
Safety
Is there a role for systole?
Diagnosis of coronary artery disease
Coronary stenosis
Coronary subocclusion
Coronary occlusion
Coronary stenting
Coronary grafts
The posterior descending and the squaring of the circle
Acute coronary syndromes
Aortic counterpulsation
Apical thrombosis
Coronary vasomotor tone and the "third dimension" of Doppler
Which role for the microcirculation?
A call for help
The future
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